Preparing for Safe Use of Imported Acetaminophen for Children
Health Canada has authorized the importation of acetaminophen products for retailers, in addition to the acetaminophen product that can be imported for hospital inpatient use. Furthermore, Health Canada has authorized the importation of an ibuprofen product with the same concentration as the corresponding Canadian product for hospital use. With foreign products with different concentrations appearing on the Canadian market, the Institute for Safe Medication Practices (ISMP) Canada has published a Safety Bulletin that provides advice to pharmacy teams about preparing for the safe use of imported acetaminophen for children. The following are highlights from the bulletin:
- The introduction of imported products into the medication-use system must be carefully managed to mitigate risks, such as the potential for medication errors.
- Hospitals will continue to have access to the Canadian acetaminophen product for infants aged 0-23 months (80mg/ml) and can use the acetaminophen product imported from Australia (24mg/ml) for children aged 2-11 years. Familiarity of healthcare workers with the Canadian products for infants (80mg/ml) and children (32mg/ml) necessitates a coordinated risk management strategy to prevent dosing errors with the Australian product (24mg/ml).
- The products imported for retailers share the same concentration (160 mg/5 mL = 32 mg/mL) and intended age group (2–11 years of age) as the Canadian acetaminophen products that are currently in shortage. Canadian acetaminophen products for infants (under two years of age) have a different concentration (80 mg/ml) than the imported product.
In consideration of the different concentrations of products that may be available, it is important that pharmacy teams spend the time necessary to educate parents and caregivers about selecting the correct analgesic and determining the appropriate dose and volume to administer from the available products.
If your pharmacy team provides imported children’s acetaminophen products to your patients, you are encouraged to review the bulletin to help ensure proper dosing.
Managing Limited Supply of Pediatric Suspensions
Certain antibiotic, analgesic and antiviral suspensions may be in short supply in Canada. These drugs typically require prompt initiation of treatment for acute conditions. Delays in prescription and over-the-counter (OTC) product availability can be detrimental to the health of pediatric patients and can result in unnecessary usage of emergency departments, further compromising patients of all ages.
When dealing with prescription pediatric drug shortages, it is imperative that pharmacists collaborate with prescribers when indicated and that communication is clear and understood by caregivers. Collaboration and communication are key to limiting delays in treatment for your patients and preventing medication incidents.
In some instances, it may be necessary to administer adult formulation medications in their original or altered form. When doing so, pharmacists must ensure this method of administration is still safe and effective.
Compounding may be considered when all other options have been exhausted and the requirements of Health Canada’s Policy 51 are fulfilled. Compounding must be completed in accordance with NAPRA’s compounding standards. The College has been made aware of compounding errors for pediatric acetaminophen suspensions in other jurisdictions. Some best practices to consider when compounding these OTC products include the following:
- Keep the concentration the same as the current commercial products to minimize confusion regarding the appropriate dose.
- The total volume dispensed should not exceed the toxic amount for an infant or child and should be consistent with commercially available formulations.
- Provide caregivers with dosing instructions in both millilitres and milligrams and a max dose per day based on the weight of their child for the specific product provided.
Please see below a few organizations and their resources for managing drug shortages of pediatric suspensions:
Medication Administration Tips (includes tips and considerations when administering adult medications whole, crushed or opened to pediatric patients)
The Canadian Pediatric Society
Health and Wellness for Healthcare Professionals
As highly accessible healthcare practitioners, pharmacy professionals play a key role in helping patients with mental illness or injury. From medication management to addiction counselling, pharmacists consistently support patients’ mental health and wellness. The College of Pharmacists of Manitoba (CPhM) commends pharmacy professionals for their dedication to patients during challenging and stressful times. CPhM also acknowledges and would like to emphasize the importance of taking care of your personal mental health as well.
Amid cold and flu season, administering vaccines, and staff shortages, pharmacy professionals have also been dealing with drug supply issues. Patients are turning to pharmacists to help manage their health care needs and assist them in coping with these challenges, leading to higher stress levels and increased workloads for pharmacy and healthcare teams.
As healthcare practitioners, addressing and taking care of your mental health is essential as it grants you the resiliency to care for others during challenging times and beyond.
If you feel the burden of these challenges at work taking a toll on your mental health, or you notice that a colleague may need some help, please review or share the resources below for support.
Canadian Mental Health Association
- Tips for managing anxiety
- The Canadian Mental Health Association developed a helpful article on how to turn down the volume on difficult or overwhelming thoughts and feelings.
Canadian Pharmacist Association
- Resilience: A Primer for Pharmacists
- Watch the recording of the Canadian Pharmacist Associations’ 2019 webinar or download the slide deck to learn strategies for managing stress and burn out. The webinar provides some foundational strategies you can use to support your mental health.
Klinic Community Health
- Crisis Support
- For those needing immediate support, please contact Klinic Crisis. They operate a variety of crisis phone lines and online support services, providing free and confidential counselling, support and referrals for people who are suicidal, in crisis or struggling to cope.
If you recognize that you or a colleague is in distress, it is best to seek support or encourage your colleague to do so, however, please note, concerns must be reported to the regulator if practice is or has the potential to be impacted and patient safety is a concern.
2023 Licence to Print for Display
Earlier this fall, the College of Pharmacists of Manitoba conducted its annual registration and licence renewal.
Pharmacists who applied to renew a practice licence for the 2023 Practice Year will soon receive notice, by direct email, that the 2023 licence is available for print and display, as long as you have met all obligations and requirements for a licence to practice.
Pharmacy managers will soon receive similar notice of the pharmacy licence available to print and display, as long as all obligations and requirements have been met.
If you require clarification or have any questions, please contact firstname.lastname@example.org for assistance.
It is the official Public Register, at www.cphm.ca that provides the absolute determinant of an individual’s status with the College and is the most reliable method of verifying an individual’s registration and licence status. The Public Register is used by the general public, employers, and other health regulators to confirm an individual’s registration status.
Consultation for Feedback on the Rural, Remote and Underserved Populations: Access to Prescribed Medications Joint Practice Statement
Rural, remote, and underserviced populations are at risk for potentially harmful delays in care because of barriers to timely access to services. Taking this into account, Manitoba’s Nursing Colleges, the College of Physicians and Surgeons of Manitoba, and the College of Pharmacists of Manitoba (CPhM) collaborated to create a joint practice statement entitled Rural, Remote and Underserved Populations: Access to Prescribed Medications (the joint practice statement). The joint practice statement was approved in April 2018 and is currently in effect.
CPhM is launching a consultation on the joint practice statement to gather feedback on its use in pharmacy practice. Pharmacy professionals who provide care to rural, remote and underserviced populations are encouraged to participate in the consultation.
The consultation is open until December 12, 2022, and can be accessed via the following link https://www.surveymonkey.com/r/6KST5MD.
CPhM Office Schedule During Holiday Season
The College of Pharmacists of Manitoba will observe the following holiday schedule:
- Closed Monday, December 26, 2022, through Monday, January 2, 2023.
- Regular office hours resume on Tuesday, January 3, 2023, 8:30 a.m. to 4:30 p.m.
Please be reminded that CPhM has pandemic-response protocols in place. All CPhM services continue, however adjustments in service delivery or delays may occur. Please call ahead before visiting the CPhM office to ensure staff are available to help you.
Documents may be left in the black deposit box to the left of the main entrance. Email is the most efficient means by which to contact staff. Thank you for your kind attention and cooperation.